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Location and allocation: inequity of access to liver transplantation for patients with severe acute-on-chronic liver failure in Europe

Artzner, Thierry; Bernal, William; Belli, Luca S; Conti, Sara; Cortesi, Paolo A; Sacleux, Sophie-Caroline; Pageaux, George-Philippe; ... ELITA/EF-CLIF working group; + view all (2022) Location and allocation: inequity of access to liver transplantation for patients with severe acute-on-chronic liver failure in Europe. Liver Transplantation , 28 (9) pp. 1429-1440. 10.1002/lt.26499. Green open access

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Abstract

BACKGROUND: There is growing evidence that liver transplantation (LT) is the most effective treatment for acute-on-chronic liver failure grade-3 (ACLF-3). This study examines whether and how this evidence translates into practice by analyzing the variability in intensive care unit (ICU) admissions, listing strategies and LT activity for ACLF-3 patients across transplant centers in Europe. METHODS: Consecutive patients who were admitted to the ICU with ACLF-3, whether or not they were listed and/or transplanted with ACLF-3 between 2018 and 2019 were included across 20 transplantation centers. RESULTS: 351 patients with ACLF-3 were included: 33 had been listed prior to developing ACLF-3 and 318 had not been listed at the time of admission to the ICU. There was no correlation between the number of unlisted ACLF-3 patients admitted to the ICU and the number listed or transplanted whilst in ACLF-3 across centers. In contrast, there was a correlation between the number of patients listed and the number transplanted whilst in ACLF-3. 21% of patients who were listed whilst in ACLF-3 died on the waiting list or were delisted. The percentage of LT for ACLF-3 patients varied from 0%-29% of patients transplanted with decompensated cirrhosis across centers (average = 8%), with an I2 index of 68% (95% CI: 49%-80%), showing substantial heterogeneity among centers. The one-year survival for all patients with ACLF-3 was significantly higher in centers that listed and transplanted more ACLF-3 patients (>10 patients) than in centers that listed and transplanted fewer: respectively 36% vs. 20%, p = 0.012. CONCLUSION: Patients with ACLF-3 face inequity of access to LT across Europe. Wait-listing strategies for ACLF-3 patients influence their access to LT and, ultimately, their survival.

Type: Article
Title: Location and allocation: inequity of access to liver transplantation for patients with severe acute-on-chronic liver failure in Europe
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/lt.26499
Publisher version: https://doi.org/10.1002/lt.26499
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Acute-on-Chronic Liver Failure, Intensive care, Liver transplantation, Waiting list
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10149844
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